A recent study from the International Journal of Geriatric Psychiatry found that more than 27% of older adults have symptoms of anxiety that significantly impact their functioning. As a caregiver, it's important to be aware of the impact that anxiety can have on your loved one.
Anxiety disorders in seniors should not be confused with worrying. It's common for individuals of all age groups to be worried from time to time. However, these feelings are not the same as an anxiety disorder. For those who are experiencing excessive anxiety on a regular basis, it's important to diagnose and treat the issue as soon as possible. Anxiety disorders can greatly diminish your loved one's quality of life. And it's unnecessary. Mental health conditions are common and treatable.
Let's talk about the risk factors, types of disorders, diagnosis, and treatment, so you can assist your loved one with anxiety symptoms and guide them toward recovery.
Risk Factors for Anxiety Disorders
While anxiety can happen to anyone, anxiety in older adults has been linked to several risk factors, including:
- Traumatic experiences
- Excessive worry with physical health
- A difficult childhood
- Consistent daily stress
- Physical limitations
- Prescription medication abuse
- Alcohol or recreational drug abuse
- Taking steroids, stimulants or antidepressants
- Insomnia and other sleep issues
- Chronic medical conditions such as diabetes, COPD and thyroid disease
- Experiencing loss, especially recent losses
If your loved one has any of these risk factors, read the symptoms of anxiety disorders in the next section to see if you recognize their behavior.
Types of Anxiety Disorders
Acute Stress Disorder
Acute stress disorder is a condition that occurs when seniors experience short bouts of anxiety or disturbances in regular behavior following a traumatic event. This type of anxiety disorder is used to describe anxiety issues that occur within a month of the extreme trauma. If your loved one recently experienced a trauma (such as a fall), it's important to talk to their physician if you have concerns about their anxiety.
Generalized Anxiety Disorder
Generalized Anxiety Disorder, or GAD, is a condition where an individual experiences patterns of excessive worry over everyday events. Typically, these are very common events, such as the mail arriving on time, but the individual cannot grasp the fact that there's no need to worry about it happening as planned.
Typically, individuals with GAD always expect the worse and interpret every issue as being much more negative than the reality. Many individuals with this condition know that they are exaggerating and being overly anxious, but they are powerless to stop their reaction. These individuals are often restless and easily startled. Many seniors with GAD also experience insomnia. Caregivers should be on the lookout for issues with substance abuse, as this is quite common in those with this anxiety disorder.
Panic attacks are sudden feelings of terror that strike repeatedly and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, and fear of dying. Some individuals will have one panic attack in their entire life; others will get them quite frequently. They are much more common in women. Sometimes issues with dementia or sun-downing can be confused with panic attacks.
Any person who sees a senior having a panic attack should approach them in a calm and gentle manner. It's important to remove the senior from crowded areas and allow them to sit in a quiet, safe place or even lie down. Breathing is one of the most important things an individual can do when they are having a panic attack. Slow, deep breaths can promote relaxation and help the individual snap out of their attack.
For those that have one or two panic attacks in their life, there's typically no reason to get professional help. However, for those who experience frequent panic attacks, a professional may be able to help them learn relaxation techniques, identify the warning signs of an impending panic attack, or prescribe medication so they can get the help they need to overcome this issue.
There are many people who experience an irrational fear of items or events ranging from flying to spiders. Many times, seniors will have battled phobias their entire lives, but there are instances when phobias worsen with time or when the individual experiences a traumatic event that causes them to start developing a true phobia.
Seniors with obsessive-compulsive disorder (OCD) suffer from recurrent unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals, such as hand washing, counting, checking or cleaning, are often performed in hope of preventing obsessive thoughts or making them go away.
Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder, also known as PTSD, is increasingly common in senior adults. Persistent symptoms occur after experiencing a traumatic event such as violence, abuse, natural disasters, or some other threat to a person's sense of survival or safety. Common symptoms include nightmares, flashbacks, numbing of emotions, depression, hyper-vigilance, being easily startled, and feeling angry, irritable or distracted.
PTSD, especially when untreated, does not simply go away. There are people that live with this anxiety disorder their entire lives. It's never too late to take a senior to a professional for help with PTSD. Seniors will often need a balance of counseling and medication to ultimately overcome or manage their disorder.
Social anxiety disorder (also referred to as social phobia) is a type of anxiety disorder that causes extreme fear in social settings. Seniors with this disorder have trouble talking to people, meeting new people, and attending social gatherings. They fear being judged or scrutinized by others. They may understand that their fears are irrational or unreasonable but feel powerless to overcome them. Often, this is a lifelong problem that could be exacerbated by age.
Diagnosing Anxiety in Seniors
Diagnosing an anxiety disorder in an older person is challenging. Seniors have more medical conditions, realistic concerns about their physical problems, and a higher use of prescription medications. The question is: are their physical symptoms related to a medical condition or an anxiety disorder?
For that reason, it's best to start with their primary care physician. Many older adults feel more comfortable talking to someone with whom they already have a relationship. Also, if they trust their doctor, they're more likely to agree with treatment or follow through with a referral to a mental health professional.
You may also want to try a mental health screening. This is not a diagnosis, but a way of understanding if the symptoms are severe enough to seek help from a doctor or other professional. Visit Mental Health America for a free anxiety screening. This could open the door to more discussion with your loved one.
Many seniors with mental health issues remain undiagnosed because they come from an era when seeking mental health treatment was shameful. This attitude has changed considerably and many seniors may be more open to help seeking than they were in the past.
Why It Is Important to Address Anxiety in Seniors
Anxiety disorders can make health conditions worse and can even precipitate new health problems. Experiencing anxiety is stressful and causes a cascade of biochemical changes that cause inflammation and raises the risk other serious health conditions.
For example, anxiety about falling can cause a senior to be more sedentary, which further erodes muscle tone and balance. Sleep deprivation from insomnia or anxiety interferes with the natural healing processes that occur in the body during sleep.
Anxiety Treatment Options
The most common and effective treatment for anxiety is a combination of therapy and medication, but some may benefit from just one form of treatment.Anti-depressants (specifically selective serotonin reuptake inhibitors or SSRIs) are preferred for seniors rather than anti-anxiety medication (such as benzodiazepines). However, since the elderly typically have medical conditions and take more medications (prescription, over-the-counter and herbal supplements) than younger anxiety sufferers, they are at a higher risk for complications due to anxiety medications. Caregivers should monitor side effects closely.
Cognitive Behavioral Therapy (CBT) has increased as a treatment option. This may involve relaxation training, cognitive restructuring (replacing anxiety-producing thoughts with more realistic, less catastrophic ones), and exposure (planned, gradual encounters with feared objects or situations) to develop healthier thought patterns. To find a therapist who specializes in anxiety disorders, you can search the database of the Anxiety and Depression Association of America. A physician may also provide a referral.
Paying for Anxiety Treatment in Seniors
Medicare can help cover treatment for anxiety. Visit the Medicare QuickCheck® to learn more about all the mental health services available through Medicare.
Medicare Part A (hospital insurance) helps cover mental health care if you're a hospital inpatient. Part A covers your room, meals, nursing care, and other related services and supplies.
Medicare Part B (medical insurance) helps cover mental health services that you would get from a doctor as well as services that you generally would get outside of a hospital, like visits with a psychiatrist, clinical psychologist or clinical social worker, and lab tests ordered by your doctor. Part B may also pay for partial hospitalization services if you need intensive coordinated outpatient care.
Medicare Part D (prescription drug coverage) helps cover drugs you may need to treat a mental health condition.
For many seniors, anxiety isn't a new experience. Most older adults with an anxiety disorder had one when they were younger. The normal stresses and vulnerabilities of the aging process have triggered the disorder. It's understandable. With cognitive declines, physical problems, and emotional losses, anxiety is bound to rear its ugly head. However, with the right anxiety treatment, your loved one can have a better quality of life.